PDF
ePub
Citation
Print
Abstract
Study Design
Eighteen patients undergoing bone cement augmentation of pedicular screwing for osteoporotic lumbar spine were reviewed retropectively.
Objectives
To assess the effectiveness of bone cement augmentation of pedicular screwing for osteoporotic lumbar spine.
Summary of Literature Review
For the technical limit obtaining the dynamic stability in the bone- screw interface for osteoporotic lumbar spine, the additional device to enhance pedicular screw fixation strength needs.
Materials and Methods
We reviewed 18 cases undergoing pedicular screwing and fusion for the osteoporotic (Jikei grade I, II, III/III) lumbar spine from Feb. 2000 to Mar. 2001 with an average followup of 1.5 years. Mean age was 69.5 years with 6 male and 12 female. Inclusion criteria was 9 degenerative spinal stenosis, 5 spinal stenosis associated with compression fracture, 2 Kummel's disease, 1 spondylolisthesis and 1 internal disc disruption. We performed bone cement injection around the screws showing significantly low insertion torque, screw pullout or cutup during surgery. We asssessed the radiographic results of sagittal angle correction (SA C) of the fused segment and disc height restoration (DHR) on the preoperative, postoperative and last follow up lumbar lateral views. Clinical results were evaluated according to the Kumano’s criteria.
Results
Mean sagittal angle at preoperative, postoperative and last followup was 11.6- 21.6- 19.6° with mean SA C gain 10°(p<0.05) and gain loss 2˚ (p>0.05). Mean disc height of each period was 33.3- 49.8- 43.5% with mean DHR gain 16.5% (p<0.05) and gain loss 6.3% (p>0.05). The clinical result was analyzed as 14 good, 3 fair and 1 poor. Fusion success was achieved in all. There were 2 perioperative complications of 1 superficial surgical site infection and 1 incomplete L4 root injury, and 6 complications during follow up of 3 compression fractures above fused segment, 1 screw pullout, 1 screw cutup, and 1bone cement extravasation into canal.
REFERENCES
1). Brantigan JW, Steffee AD, Lewis ML, Quinn LM, Persenaire JM. Lumbar interbody fusion using the Brantigan I/F Cage for posterior lumbar interbody fusion and the variable pedicle screw placement system. Spine. 25:1437–1446. 2000.
2). Brantley AGU, Mayfield JK, Clark KR. The effect of pedicle screw fit-An in vitro study. Spine. 19:1752–1758. 1994.
3). Coe JD, Warden KE, Herzig MA, McAfee PC. Influence of bone mineral density on the fixation of thoracolumbar implants: A comparative study of transpedicular screws, laminar hooks and spinous process wires. Spine. 15:902–907. 1990.
4). Grubb SA, Lipscomb HJ. Results of lumbosacral fusion for degenerative disc disease with and without instrumentation-two to five year followup. Spine. 17:349–355. 1992.
5). Halvorson TL, Kelley LA, Thomas KA, Whitecloud TS, Cook SD. Effect of bone mineral density on pedicle screw fixation. Spine. 19:2415–2420. 1994.
6). Hasegawa K, Takahashi HE, Uchiyama S, et al. An experimental study of a combination method using a pedicle screw and laminar hook for the osteoporotic spine. Spine. 22:958–963. 1997.
7). Hu SS. Internal fixation in the osteoporotic spine. Spine. 22:43S–48S. 1997.
8). Kim EH, Lee KB, Cho DY. A comparison of flexible and rigid rods system in transpedicular screw fixation of degenerative lumbar spine. J Korean Orthop Assoc. 34:103–110. 1999.
9). Kim EH, Woo BC, Koh ES, Cho DY. The Change of Segmental Sagittal Angle in Low-grade Spondylolisthesis after Pedicular Screw Fixation with or without PLIF. J of Korean Orthop Assoc. 32:1098–1106. 1997.
10). Kim KS, Kim Y, Kim ST, Koh JW, Choi YS. Surgical management of Extensive degenerative lumbar steno -sis. J Korean Orthop Assoc. 27:488–501. 1992.
11). Kumano K, Hirabayashi S, Ogawa Y, Aota Y. Pedicle Screws and Bone Mineral Density. Spine. 19:1157–1161. 1994.
12). Okuyama K, Sato K, Abe E, Inaba H, Shimada Y, Murai H. Stability of transpedicle screwing for the osteoporotic spine-An in vitro study of the mechanical stability. Spine. 18:2240–2245. 1993.
13). Soshi S, Shiba R, Kondo H, Murota K. An experimental study on transpedicular screw fixation in relation to osteoporosis of the lumbar spine. Spine. 16:1335–1341. 1991.
14). Zdeblick TA, Kunz DN, Cooke ME, McCabe R. Pedicle screw pullout strength: Correlation with insertion -al torque. Spine. 18:1673–1676. 1993.
15). Zindrick MR, Wiltse LL, Widell EH, Thomas JC, Wol-land WR, Field BT, Stencer CW. A biomechanical study of intrapeduncular screw fixation in the lumbar spine. Clin Orthop. 203:99–112. 1986.
Figures and Tables%
Fig. 1.
A 66-year-old female with spinal stenosis at L3-4-5 associated with compression fracture of L4 and L5 bodies. Preoperative AP and lateral radiographs show Jikei grade II/III osteoporosis with –4.1˚ of local L3 to L5 kyphosis (A). Postoperative radiographs after L3-4-5 cage-PLIF and PMMA augmentation for Rt L3 and L5 screws (black arrows) show satisfactory correction of L3 to L5 sagittal angle to 14.3˚ (B). The 1.5-year followup examination shows L1 compression fracture (white arrow) from slipped down accident (C). Two weeks after fracture we performed percutaneous L1-vertebroplasty (D), and 2.2-year followup radiograph shows only a minor loss of the correction and no device-related problems (E).
Table 1.
Indications of operation
Table 2.
Sagittal angle correction
| Pre-Op | Post-Op | Last F/U | |
|---|---|---|---|
| Mean SA∗ | 11.6˚ | 21.6˚ | 19.6˚ |
| SAC∗∗ Gain | (10˚) | ||
| SAC Loss | (2˚) | ||
Table 3.
Disc height restoration
| Pre-Op | Post-Op L | Last F/U | ||
|---|---|---|---|---|
| Mean DHR∗ | 33.3% | 49.8% | 43.5% | |
| DHR Gain | (16.5%) | |||
| DHR Loss | (6.3%) | |||
Table 4.
Postoperative complications (N=18)
| perioperative | during F/U | |
|---|---|---|
| Incomplete L4 root palsy | 1 | |
| Superficial SSI∗ | 1 | |
| Compression fracture above | 3 | |
| fused segment | ||
| Screw pullout | 1 | |
| Screw cutup | 1 | |
| Bone cement extravasation into canal during revision | 1 | |
| Total | 2 (11.1%) | 6 (33.3%) |
XML Download